Comparison Of Clinical Characteristics And Drug Resistance Of Peritoneal Dialysis Associated Peritonitis Infected By Gram-positive Bacteria And Gram-negative Bacteria

ObjectiveTo compare the clinical characteristics of peritoneal dialysis associated peritonitis caused by gram-positive bacteria(G~+bacteria)infection and gram-negative(G~-bacteria)infection and analyze the risk factors of G~-bacteria infection peritonitis,and analyze distribution of pathogenic bacteria and the drug resistance of main pathogenic bacteria,so as to provide reference for early identification of pathogenic bacteria types and targeted anti-infection treatment.Methods87 cases of patients with peritoneal dialysis associated peritonitis and positive pathogen culture treated in the Nephrology Department,the Second Affiliated Hospital of Anhui Medical University from January 2018 to January 2022 were retrospectively analyzed.According to sputum bacterial culture identification results,patients were divided into the gram-negative bacteria infection group and gram-positive bacteria infection group.Compare the general data,clinical manifestation,laboratory examination,treatment outcome of gram-positive bacteria infection group and gram-negative bacteria infection group,and analysis relevant differences.The risk factors of peritonitis caused by gram-negative infection were analyzed by binary logistic analysis,and the predictive value of risk factors was evaluated by ROC curve.The distribution of pathogenic bacteria and the drug resistance of main pathogenic bacteria were analyzed according to the results of pathogenic bacteria culture.Results(1)In terms of general information,there was no statistical difference between the G~+bacteria group and the G~-bacteria group in terms of age,gender,education level,body mass index,dialysis age,primary disease,complication(P>0.05).(2)In terms of clinical manifestations,there was no statistical difference between the G~+bacteria group and the G~-bacteria group in abdominal pain,diarrhea,constipation,fever,and turbid peritoneal dialysis fluid(P>0.05).(3)In terms of laboratory inspection,the percentage of white blood cells in peritoneal dialysis fluid,multinucleated cells in peritoneal dialysis fluid,serum calcitonin,serum C-reactive protein,red blood cell distribution width and fibrinogen level in gram-negative bacteria infection group were higher than those in gram-positive bacteria infection group(P<0.05);however,albumin,serum creatinine,blood urea nitrogen and other indicators were not statistically different between the two groups(P>0.05).(4)Binary logistic analysis showed that high serum procalcitonin(OR=1.034,95%CI 1.001～1.069,P=0.045)and high red blood cell distribution width(OR=1.499,95%CI 1.037～2.167,P=0.031)were independent risk factors for peritoneal dialysis associated peritonitis caused by G~-bacteria infection group.The analysis of ROC curve results showed that serum procalcitonin combined with red blood cell distribution width had the greatest predictive value for the occurrence of peritoneal dialysis associated peritonitis caused by G~-bacteria infection,and the area under the curve was 0.815(95%CI 0.717-0.890,P<0.001).(5)In terms of clinical outcome,the cure rate of G~+bacteria group was higher than that of G~-bacteria group,and the difference was statistically significant(P<0.05).(6)The most common G~+bacteria infection group were coagulase-negative Staphylococcus 35(55.56%)and Streptococcus 15(23.81%).The most common G~-bacteria infection group were Escherichia coli 10(41.67%)and Klebsiella pneumoniae 6(25.00%).(7)According to the results of drug resistance analysis of main pathogenic bacteria,G~+bacteria infection group are mainly completely sensitive to vancomycin and linezolid,and G~-bacteria infection group are mainly completely sensitive to amikacin and cefoperazone-sulbactam.Conclusion(1)The cure rate of peritoneal dialysis associated peritonitis infected by G~-bacteria is lower than that of peritoneal dialysis associated peritonitis infected by G~+bacteria.(2)The percentage of white blood cells in peritoneal dialysis fluid,multinucleated cells in peritoneal dialysis fluid,serum calcitonin,serum C-reactive protein,red blood cell distribution width and fibrinogen level in peritoneal associated dialysis peritonitis infected by G~-bacteria were higher than those in peritoneal associated dialysis peritonitis infected by G~+bacteria.High serum procalcitonin and high red blood distribution width are independent risk factors for peritoneal dialysis associated peritonitis caused by G~-bacteria infection.The combination of serum procalcitonin and red blood distribution width has a good predictive effect on peritoneal dialysis associated peritonitis caused by G~-bacteria infection.(3)According to the analysis of drug resistance of the main pathogens,vancomycin or linezolid as the first choice regimen of empirical anti infective treatment against G~+bacteria,and cefoperazone-sulbactam or amikacin as the first choice regimen of empirical anti infective treatment against G~-bacteria,could significantly improve the therapeutic efficacy.